Application for Employment
PART 1 - PERSONAL INFORMATION
CONFIDENTIAL
FOR OFFICE USE ONLY
Post Ref No
Applicant No
Date Received
Please complete this form fully using black ink or type and return to the address as directed on
the last page.
Post Applied for:
Service:
Job Ref No:
Section 1.1
Personal Details
Title:
Date of Birth (dd/mm/yy):
Last Name:
First Name:
Previous Names:
(if applicable)
Address:
Town/City:
Postcode:

Daytime Telephone No:
Evening Telephone No:
Mobile Telephone N0:
E-mail address:
National Insurance N0:
Are you entitled to work in the UK?
1
Email is our
preferred method of
communication and
candidates will receive
all communication via
the email address
provided. We would
advise you to check your
emails on a regular
basis.
Yes
No
Section 1.2
References
First Reference (Must be current or most recent
employer)
Second Reference
Name:
Name:
Position
(job title):
Position
(job title):
Address:
Address:
Postcode:
Postcode:
Telephone No:
Telephone No:
E-mail
address:
E-mail
address:
May we contact this
referee prior to the
interview?
Yes
May we contact this
referee prior to the
interview?
No
Employer
Reference Type
(tick as appropriate)
Academic
Yes
No
Employer
Reference Type
(tick as appropriate)
Personal/Character
Academic
Personal/Character
For posts which have substantial access to children or vulnerable adults, the Council reserves the right to
approach any previous employer.
Section 1.3
Criminal Convictions
Under the Rehabilitation of Offenders Act 1974 you are entitled to withhold information about convictions that are 'spent' under the
provisions of the Act.
Have you ever been convicted or cautioned in relation to a criminal offence, have you been bound-over, or subject
to formal warnings or reprimands or are you at present the subject of any criminal proceedings or police
investigation?
Yes
No
Please specify dates of summons, charges, cautions, reprimands, final warnings or convictions, court,
nature of offence and sentence or order imposed.
2
Any information disclosed will be treated sensitively and in confidence and will only be used in
deciding a candidate’s suitability for the post
Section 1.4
Positive about Disabled People
The Halifax Academy is committed to the Two Ticks disability standard. This means that any applicant with a
disability who meets the essential criteria for a job vacancy will be guaranteed an interview and considered
on their abilities.
Do you consider yourself to have a disability?
Yes
No
If you have answered yes to the above question, please give details of any assistance you may need at interview
(e.g. sign language interpreter, wheelchair access)
Section 1.5
Additional Information
Are you related to a staff member or Governor of the school?
Yes
No
If YES please give name, position and relationship:
I understand that canvassing, directly or indirectly in connection with this appointment or knowingly
failing to disclose a relationship will disqualify me.
To be completed for Teacher positions only:
Teacher Reference
Number
Do you hold Qualified Teacher Status?
3
Yes
No
Section 1.6
Declaration
In submitting this application (whether signed or not) I declare that I am the person referred to on the
form, I can confirm I have read the Guidance Notes for Applicants document and that the information I
have provided in Part 1, 2 and 3 of this application is true, complete and correct.
I understand that if I provide incorrect information or a false statement this will lead to the withdrawal
of any job offer, or if I am given the job this will result in disciplinary action which is likely to result in
my dismissal from employment.
I authorise The Halifax Academy to contact any current or former employers at the appropriate stage
to confirm the details provided.
I understand that, disclosing a relationship with a staff member or Governor, of which I am aware, will
disqualify me.
In accordance with the Immigration, Asylum and Nationality Act 2006 I am entitled to work in the
United Kingdom. I shall produce such original documentation as may be requested to evidence my
right to work.
I agree to the information contained in this application being processed under the Data Protection Act
1998, for the purposes of recruitment monitoring and in relation to forming any contract of
employment. I also agree to this information being used to monitor local employment targets in
partnership with Job Centre Plus as part of the Local Employment Partnership.
Signed:
Date:
This marks the end of section 1
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PART 2
EQUAL OPPORTUNITIES MONITORING DATA
FOR OFFICE USE ONLY
Post Ref No
Applicant No
Date Received
Application for the post of:
Job Ref No
Which age category do you fall into?
16-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60+ years
Rather not state
What is your Ethnic Origin?
Please choose ONE section from 1 to 6, then tick the appropriate box to indicate your cultural background.
1.
White
2.
Mixed
3.
(a) Mixed White &
Black Caribbean
(b) Mixed White &
Black African
(c) Mixed White &
Asian
(a) White British
(b) White Irish
(c) White Other
Black or Black British
(a)
Black
Caribbean
(b) Black African
(c)
5.
(a) Asian Indian
(b)
Asian Pakistani
(c)
Asian
Bangladeshi
(d)
Asian Other
Chinese or Other
6.
Undefined
(a) Chinese
(a)
Rather not state
(d) Mixed Other
4.
Asian or Asian British
(b) Other
Black Other
Gender
Male
Female
Rather not state
For the purpose of this question, transgender is defined as an individual who lives, or wants to live, in the gender
opposite to the one that they were assigned at birth.
5
Is your gender identity the same as the gender
you were assigned at birth?
Do you live and work full time in the gender role
opposite to that assigned at birth?
Yes
No
Yes
No
Yes
No
Disability
Do you consider yourself to have a disability?
Sexual Orientation
Heterosexual
Bisexual
Gay man
Rather not state
Gay woman or lesbian
Religious Belief/Faith
Christian Denominations
Jewish
Buddhist
Other
Hindu
No Religion
Muslim
Rather not state
Sikh
This marks the end of section 2
6
PART 3 APPLICATION FOR EMPLOYMENT
FOR OFFICE USE ONLY
Post Ref No
Applicant No
Date Received
Application for the post of:
Job Ref No
Section 3.1 Current or Most Recent Employment
If you are not currently employed, please give details of your most recent employment. If you have just left
education or have not been employed before then please leave this section blank.
Job Title:
Grade:
Other allowances/benefits:
Date of Appointment:
Date employment ended:
(if applicable)
Notice period (if applicable):
Employer:
Address:
Postcode:
Tel no:
Status:
e.g. Part Time/ Full Time/ Casual/ Temp:
Responsible to:
Nature of business:
Brief description of duties:
7
Salary:
Reason for leaving
(if no longer employed):
Section 3.2
Previous Employment
Previous Employment (Please put your most recent employer first).
Name and Address of
Employer
Job Title
Salary
Date From
(dd/mm/yy)
Date To
(dd/mm/yy)
Reason for
Leaving
Please give reasons for any gaps between jobs, e.g. unemployment, study, childcare etc. (specify
dates and reasons):
8
If you are successful will this be your only job?
Yes
No
If no, please state the
weekly hours and
nature of the additional
work?
Section 3.3
Education and Qualifications
Type e.g. school, college,
university, workplace
Section 3.4
Qualifications gained
(state level and grade)
Personal Development & Additional Learning
Learning & Development Activity/Course Details
9
Date
Date
Section 3.5
Professional Membership
Relevant Institute/Body
Section 3.6
Class of Membership e.g. Associate,
Member, Student, Fellow etc.
Expiry Date
State if Examination
Driving Licence Details
Note: This section should only be completed if driving is an essential requirement of the post for which you are applying
Do you hold a full, current driving licence valid in the UK?
If YES, state class: e.g. Full UK
Car, HGV, PSV, LGV etc.
10
Yes
No
Section 3.7
Personal Statement
Details of experience, knowledge, skills, abilities and other relevant information – please refer to the
person specification/job profile and guidance notes for completing this section.
11
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Returning your application
Postal applications should be returned to:
The Halifax Academy
Gibbet Street
HALIFAX
West Yorkshire
HX2 0BA
Applications can be submitted via e mail to:
admin@thehalifaxacademy.org
Enquiries:
Tel: 01422 301080
Fax: 01422 301081
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